Bjarte Folkestad

A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes

BackgroundPeople living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study.MethodsWe employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention.ResultsQualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness.ConclusionsLeadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships.Trial registrationThe trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.

Erratum to: Study protocol for a multicenter investigation of reablement in Norway

Unfortunately, the original version of this article [1] contained an error. The name of the author Eva Langeland was incorrectly spelt as Eva Langland. The correct spelling, Eva Langeland, has been included in the author list above.

Trends in Volunteering in Scandinavia

In this chapter, we examine participation rate and time use trends in volunteering in Scandinavia during the period from the beginning of the 1990s until the mid-2010s. The aim of the analysis is twofold. First, we aim to provide a descriptive analysis of the trends in volunteering in Scandinavia during the period under investigation. Second, we aim to determine whether and to what extent the socio-demographic and institutional changes in the Scandinavian societies during this period can explain the observed trends in volunteering. The results show that the overall levels of participation in volunteering are high and stable in the Scandinavian countries, with a small upward trend. The participation levels are all high in international comparisons, but they are markedly higher in Norway and Sweden than in Denmark. Volunteers’ contributions of time appear relatively stable in Norway, but Denmark has witnessed a slight decline and Sweden has witnessed a slight increase. The explanatory analysis revealed that nearly half of the upward trend in the levels of volunteering can be attributed to the expansion of education in the Scandinavian countries. The explanatory analysis also indicated that the gap in the levels of volunteering between Sweden and Norway on the one hand, and Denmark on the other hand, cannot be attributed to socio-demographic differences between the countries, as the gap is left unchanged when controlling for socio-demographic factors.

Changing Patterns of Volunteering and Participation

In this chapter, we investigate whether the Norwegian model of organizational participation and volunteering is changing due to exogenous processes of individualization, digitalization, and migration. Analyzing a varied set of data, including population surveys and qualitative case studies, some interesting and paradoxical results were discovered. Regarding the process of individualization, we identify the development of a more reflexive and individualized form of volunteering indicated by a loosening of membership bonds between individuals and voluntary organizations, a multiplication of arenas for volunteering, more short-term volunteering, and an increased self-oriented motivation for volunteering. However, we also observe stability in (high) levels, volumes and areas of volunteering (sport, leisure, and culture), and a continuing importance of local contexts for mobilizing volunteers. We see this stability as an indication of a rather successful, multifaceted reconfiguration of Norwegian civil society, in the sense that it adapts to new, more individualized motives and practices among volunteers. With regard to digitalization, we find digital media mainly to support participation and volunteering, both within and outside of traditional organizations by underpinning reflexive individualized volunteering and supporting traditional organizations informational services. With regard to immigration, analyses show lower levels of voluntary participation (tied to lower levels of education and income) among immigrants and their descendants and the formation of and larger participation in religious, immigrant- and culture-specific organizations and networks. Although these particular findings may indicate challenges for the traditional Norwegian model of volunteering in integrating the immigrant population, the overall trends found in this chapter are indicative of adaptation on the part of the Norwegian model to larger social processes of change.

The 2015 Norwegian Local Elections: Support for Governing Radical Right Progress Party Plummets and Great Gains for Greens in ‘Second-Order’ Elections

ABSTRACT Two years into the first term of the right wing Conservative/Progress Party coalition government, the 2015 Norwegian local elections displayed many features of a ‘second-order’ election: the governing parties lost considerable support, minor parties did well and voter turnout was low. For the second local elections in a row, political circumstances prevented the far right Progress Party from mobilizing on the anti-immigration issue, adding to the burdens of governing nationally for the first time. The Green Party leveraged its 2013 entry into the national parliament into record support, consolidating the progress made in the 2011 local elections. Although the elections were shaped by national politics, municipal and county variation shows that local political factors did matter.

Predictors of outcomes following reablement in community-dwelling older adults

Background Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. Objective The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up. Methods The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM). Results The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. Conclusion The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement.